Insulin pump therapy viable option vs. injections for older adults
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Older adults with type 1 diabetes may be able to reduce HbA1c and the occurrence of hypoglycemia, diabetic ketoacidosis and hospitalization by using subcutaneous insulin infusion instead of insulin injection therapy, according to findings published in Diabetic Medicine.
“With better treatment options and increasing life expectancy, the population of older people with type 1 diabetes is growing. This leads to increasing demand for treatment options tailored to the needs of older adults with type 1 diabetes,” Jennifer Grammes, Dipl-Psych, a doctoral researcher of health psychology at the Johannes Gutenberg University Institute of Psychology in Mainz, Germany, and the Diabetes Technology Working Group in Ulm, Germany, and colleagues wrote. “Among the available treatment options for type 1 diabetes, continuous subcutaneous insulin infusion has become increasingly popular and has gained widespread acceptance in diabetes care.”
Grammes and colleagues evaluated mean HbA1c and insulin dose requirements as well as the incidence of retinopathy, neuropathy, microalbuminuria and depression in Diabetes Prospective Follow-up Registry participants across a 1-year period. The researchers also evaluated the incidence of severe hypoglycemia and diabetic ketoacidosis as well as the mean number of days in which participants were hospitalized. All participants were aged at least 60 years and had type 1 diabetes, including 1,404 who used subcutaneous insulin infusion (median age, 66.4 years; 52% women) and 8,143 who used insulin injection therapy (median age, 70.5 years; 51% women).
According to the researchers, a greater proportion of adults with type 1 diabetes aged at least 60 years used subcutaneous insulin infusion in 2018 (23%) compared with 2008 (12%).
“Our results show that the population of people with type 1 diabetes aged 60 years using subcutaneous insulin infusion is increasing and emphasize the importance of more studies to provide a tailored approach to insulin therapy for this vulnerable group of individuals,” the researchers wrote.
The average HbA1c for subcutaneous insulin infusion users was 7.7% compared with 7.9% for those who used insulin injection therapy (P < .001). The average insulin dose for subcutaneous insulin infusion was 0.49 IU/kg per day compared with 0.61 IU/kg per day for those who used insulin injection therapy (P < .001). The rate of severe hypoglycemic events was 0.16 per person-year for subcutaneous insulin infusion users compared with 0.21 per person-year for insulin injection therapy users (P = .001). The rate of diabetic ketoacidosis events was 0.06 per person-year for subcutaneous insulin infusion users and 0.08 per person-year for insulin injection therapy users (P = .003). Subcutaneous insulin infusion users also averaged 8.1 days in the hospital per person-year compared with 11.2 per person-year for insulin injection therapy users (P < .001).
However, 65% of subcutaneous insulin infusion users and 60% of insulin injection therapy users had neuropathy (P = .001), whereas depression occurred in 11% of subcutaneous insulin infusion users compared with 6.4% of insulin injection therapy users (P < .001). Meanwhile, 14% of subcutaneous insulin infusion users experienced microalbuminuria compared with 19% of insulin injection therapy users (P < .001).
“Subcutaneous insulin infusion is a proven safe and effective treatment option for older people with type 1 diabetes,” the researchers wrote. “Hence older age in itself should not be seen as an exclusion criterion for the use of subcutaneous insulin infusion.” – by Phil Neuffer
Disclosures: The authors report no relevant financial disclosures.
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